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Istoriya meditsiny Istoriya meditsiny (History of ) CONTENTS () 2015. Vol. 2. № 1 2015. Vol. 2. № 1

GENERAL ASPECTS OF HISTORY AND OF MEDICINE

Galen’s : Aristotelian Heritage or Scientifi c Innovation? V.L. Vasyukov ...... 3 The evolution of Vesalius’s perspective on ’s anatomy D. Lanska ...... 13 Galen as Read and Perceived by Medieval Islamic Medicine H. Ebrahimnejad ...... 27

FROM THE HISTORY OF HEALTHCARE

Formation of health insurance in Yaroslavl province E.M. Smirnova ...... 39

INTERDISCIPLINARY RESEARCH

The social status of in Ancient Egypt O.A. Jarman, G.L. Mikirtichan ...... 48 From the Tokyo to Khabarovsk trials: the history of the preparation of the trial of Japanese war criminals and bacteriologist V.V. Romanova ...... 61 The Venetian editions of Galen of the second half of 16th century as a source of information on the history of medicine P.A. Shamin ...... 70

SPECIFIC QUESTIONS IN THE HISTORY OF MEDICINE

Hippocrates, Celsus and Galen: Head Injury, the Brain, and the Bone J. Ganz ...... 78

SOURCE

Natural philosophy and principles of general in the Galen system (as exemplifi ed by the Ars Medica treatise). Part 1 D.A. Balalykin ...... 89 Returning the medical writings of surgeon and Bishop V.F. Voyno-Yasenetsky to scientifi c use M.N. Kozovenko ...... 113

On the ligation of vessels in spleen removal (Bishop Luke) ...... 116

The need to increase the extent of for malignant tumors of the breast (Bishop Luke) ...... 118

Request for quotation: We ask readers of the English version of “Istoriya meditciny” (“History of Medicine”) journal to use for quotation the Russian issue details (journal title, volume, number, pages), listed at the end of the each article.

2 Istoriya meditsiny (History of Medicine) 2015. Vol. 2. № 1. DOI: 10.17720/2409-5834.v2.1.2015.03e

Galen as Read and Perceived by Medieval Islamic Medicine H. Ebrahimnejad, Doctor of Philosophy, Professor University of Southampton, UK

The infl uence of Galen in Islamic countries is associated with the extensive contribution of Greek scientifi c in the pre-Islamic and Islamic periods. Islam as a religion and a political force, competing with Christianity and the Byzantine Empire, was instrumental in spreading the heritage of Greek medicine. It originated in a geographical and cultural sphere near Hellenistic civilization. For development and distribution, «non-Islamic» science and knowledge were needed. It appears that the dominance of Greek medical thought in Islamic culture was possible because integration of Greek intellectual heritage was part of the ideological process during the formation of Islam itself. However, Greek medicine, as it was perceived by Islam, was no longer a body of knowledge that could develop independently: it now needed to be interpreted in a special way – as Islam required it. While theoretical teaching in Hellenistic medicine was based on anatomical observations. After a period of neglect that began in the second half of the third century BC, it was again taken up by Galen in the second century AD. Theoretical innovation based on anatomy did not actually occur in Islamic medicine. A lack of any clear understanding of the practical relevance of anatomy to the development of medical knowledge led to it exclusively descriptive in medieval Islam. However, this underestimation did not explain why dissection and surgery did not develop in Islamic medicine. Religious and theoretical factors were more important. The author attempts to show how Galen was perceived in the Islamic world and, based on an analysis of Islamic reading of his works, reveals the reasons for the gap between the Christian West and the Islamic East in their approaches to .

Keywords: Galen, Islam, Greek medicine, Islamic medicine, anatomy, history of medicine

In a letter of 20 February 1657, a contemporary School of Alexandria. As intellectual heirs to this of Descartes wrote: One of Descartes’ friends school, Islamic physicians hammered home the went to visit him at Egmond, Netherlands. This importance of dissection and anatomy in medical gentleman asked him about physics books: which education. It is, however, striking that there ones did he most value and which of them did was no single dissection undertaken by Islamic he most frequently consult? “I shall show you”, physicians. In any , they were not reported replied Descartes, “if you wish to follow me”. or documented. Therefore, we have three major He led him into a lower courtyard at the back of approaches (or readings) towards the relationship his house, and showed a calf that he had planned between medicine and anatomy before the modern to dissect the next day. “Here is my library from period. They are distinguished by their inherent which I take my wisdom” answered Descartes to link between the form of : his friend [1]. Aristotelian, Galenic and Islamic. The aim of Such a library as source of medical knowledge this paper is not to examine these three historical was fi rst used by Aristotle in the 4th century BC in medicine, but to depict the impact and later by Herophilus (ca. 320‒260 BC), of Galen on medicine in Islam, explore the Erasistratus (ca. 260 BC) and then by Galen (ca. epistemological gap between the Islamic hakims 129‒216 AD). What distinguished Galen from (philosopher-physicians) in the seventeenth and earlier Hippocratic physicians were his eff orts to eighteenth century on the one hand, and their unite various medical schools, a turning point in contemporary Western counterparts on the other. the history of Greek medicine, without which they This article aims to understand why in Islam probably would not have prospered. It was Galen’s the most practical aspect in mdeicine, namely work that shaped the medical curriculum of the anatomy and dissection, were converted to “text” and knowledge of the human body was sought in books. In the West, “anatomical dissections” © H. Ebrahimnejad for Descartes were based on his prized physics

27 ISTORIYA MEDITSINY (History of Medicine) 2015. Vol. 2. № 1 books and the “Experimental Medicine” of p. 14]. His surviving works include more than Claude Bernard, (1865) as inspired Emile Zola, 120 titles, published in 22 hefty octavo volumes who dispassionately wrote about French society by Carolus Gottlob Kühn in the original Greek. in his novels. By examining the Islamic reading In Leipzig they included an accompanying Latin of Galen, this article attempts to identify the translation, 1821‒1833. Hunayn in his Risâlah factors that caused this gap between the Christian provides details about 129 works of Galen that West and Islamic East in their approach to Greek he and his collaborators translated from Greek medicine. To do this, I need to begin with into Syriac and/or Arabic [8, p. 25]. Campbell Galen and the process of the transmission of records 272 works of Galen, including some Galenic medicine into Islam, not least because it which have been lost [9]. However, none of is the process of assimilation of Greek science in these fi gures represent the entirety of Galen’s Islam that informed the way it was conceived or work [10]. The Arabic versions of Galen’s works perceived. are mostly attributed to Hunayn b. Ishâq (d. ca. 873) and his followers, such as his son Ishâq b. Galen and Hippocratic medicine Hunayn (d. 910); but others, like the well-known Throughout the Hellenistic period, various Thâbet b. Qurrah (d. 901) contributed as well. medical approaches developed, including In the interest of clarity and readability, Hunayn Hippocratic medicine1. During the first four intended his translations to be idiomatic rather years of his medical studies, Galen attended the than literal, at times achieving greater lucidity courses of almost all the then-active medical than Galen himself, but at the cost of occasional schools (or rather approaches), the Dogmatic, errors [8, p. 30; 11, p. 119]. The content of Galen’s Empiric, Methodic and the Pneumatic in lost works can also be found in citations in works Pergamon. It seems, however, that from this of later physicians such as Râzi who in his Shukuk early stage Galen was more influenced by the alâ Jâlinus quotes Galen literally, or Ebn Sina, Dogmatics, who, while following principles who in his Canon paraphrases him without of the Hippocratic teachings, believed that specifying which of Galens’ works he is citing [12, the mere observation of the exterior of the p. 191, 192]. We might also fi nd works that are body was not sufficient and a knowledge of wrongly attributed to Galen. The Tâle‘-nâma-ye anatomy was critical to medical practice [4, Jâlinus, for instance, obviously is not attributable p. 7]. As we will see, the Dogmatic approach to Galen. It is a genre of commentary in which with an emphasis on anatomy emerged a Galen’s ideas are presented through the prism of century after Hippocrates (ca. 460‒370 BC) Islamic or folk astrology [13]. under Aristotelian influence. In turn, the The translations of Galen’s works were emergence of the Empirics was a reaction to the made from Galen’s original texts and from anatomical school of Alexandria [5, p. 32]. It Late Antiquity Alexandrian summaries and was thanks to Galen that Hippocratic medicine commentaries. In Shahrazuri’s (active c. triumphed, since in his time the Methodics 685/1285) myth formulations, “from nearly 400 and the Empirics were more numerous and small and large tracts of Galen, [a summary probably more successful [6, p. 658]. Although made in] sixteen volumes were [at the most] read Galen criticised the Empirics, believing that by medical students” [14, p. 332]. Shahrazuri knowledge of inner structures and functions would refer here to what “Onsor al-Ma‘âli”, was essential to successful medical practice, he writing in 475/ca. 1082 [15, p. 213], and Nezâmi- combined the two approaches of dogmatism ye “Aruzi”, writing in 550/1155 [16, p. 110], and scientific experimentation, a method that called the “Sixteen Books”, setta-ye zaruriya, was followed by Islamic physicians [7, p. 21]. and that recommended to medical students. Sometimes these Sixteen Books are mistaken for Galen’s works another set of text books based on Galen’s works Galen began writing when he was a teenager called Jawâme‘ al-Eskandarânîyîn or Summaria and continued until nearly the end of his life [5, Alexandrinorum. According to Savage-Smith [17, p. 126, 127, 131, 138], the “Sixteen Books” were 1 On Hippocrates and Hippocratic medicine, see: [2, 3]. written by Galen himself for “the beginner”,

28 H. Ebrahimnejad while the so called Javâme‘ al-Eskandarânîyîn discontinuity. The possibility of a continuation were the abridged version [by the Alexandrian of Iranian tradition in medical writings which physicians] of the sixteen Books [8, p. 13]. This did not pass through Arabic texts in the Islamic assertion is supported by Ibn al-Qifti’s notes period remains uncertain [22, p. 142]. However, (died in Egypt in 1248) that the Eskandarânîyîn with regard to patient-doctor relationship, there were those who prepared abridged works of are elements of continuity that bypassed Greek Galen (jam‘-e kalâm-e Jâlinus) [18, p. 97]. infl uence. According to the Hippocratic Oath, Ullman that the prolixity and partial the interest of patient, regardless of social status contradictions in Galen’s original works resulted or religious conviction, is central to the work in the Islamic physicians having recourse to the of the [3, p. 59]. However, according summarised or coherent translation (in form of to the Vandidad, the part of the Avesta where Javâme‘-e Eskandarânîyîn or Sett-ye zaruriya) medicine is discussed, a Zoroastrian physician [19, p. 10]. However, it seems that as far as may treat a worshiper of Ahura Mazda only if he the Javâme‘-e Eskandarânîyîn is concerned, has three times successfully treated worshipers its importance for the Islamic physicians was of Daeva (or the unbelievers). If he fails only more fundamentally related to the importance once and the worshiper of Daeva dies, he is not of both Alexandrian medicine and Aristotelian allowed to treat a Zoroastrian patient. On the philosophy in Islam2. other hand, if the physician treats a worshiper of Ahura Mazda and the patient dies, the physician Galen and Islamic medicine will be subjected to the of barodhô-Varstha, Galen’s infl uence on Islamic countries is or death penalty [23, p. 11, 12]. A similar linked to the wider impact of Greek sciences discrimination was observed in Islamic . during the pre-Islamic and Islamic periods. In ‘Onsor al-Ma‘âli advised physicians to undertake the pre-Islamic period, this was partly due to the numerous experimentations on ordinary or poor introduction, or formation, of Hellenistic culture patients in hospitals, but not on noblemen [to in the aftermath of the conquest of vast regions of acquire the skill necessary for the treatment of Westeren Asia and the Middle East by Alexander the latter], despite the fact that he recommended of Macedonia (356 BC‒323 BC). It can also be the physician read the Hippocratic Oath [15, p. partially attributable to the introduction of Greek 215, 216]. However, this contrast has theoretical sciences into Middle Persia, i.e. Pahlavi, under rather than practical value. The Hippocratic the Sasanian kings. The ninth-century Pahlavi Oath advocates the ideal form of doctor-patient compilation Wizidâgihâ i Zâdsparam, known relationship and it is unlikely that in Ancient by its author, the priest-physician Zâdsparam, Greece poor patients, including slaves or propounded the four humours (âb) – blood members of the Plebs, were never used as objects (khun), phlegm (drêm), red bile [Pahlavi of medical investigation. This improved medical transcription following MacKenzie] (wish i knowledge would be used for the benefi t of the suxr), and black bile (wish i syâ). This echoed wealthy. Greek humoral physiology and may be indicative To appreciate Galen’s infl uence on Islamic of Greek infl uence on Sasanian medicine [8, medicine, it needs to be viewed and studied p. 17]. According to some scholars, the religious from a wider context. Two questions remain in Sasanian text of Denkart treated Greek sciences this medical historiography. The fi rst is why the was part of Zoroastrian canons and that this was Moslems assimilated Greek sciences, Greek indicative of the pre-Islamic origins of Greek medicine in particular. The second question is infl uence in Iran [20, 21]. However, medical why, despite adopting Greek science, the very literature in Iran after the advent of Islam had principle of inquiry into nature was neglected an entirely diff erent origin. The linguistic and and at times refuted. It is often held that Greek religious break with the pre-Islamic period sciences were transmitted to Islam through the might be viewed as the main factors of this Sasanian channels. This is because the Abbasid 2 About the role of the Nestorian physicians in the Caliphate, under which Islam reached its apex in transmission of Alexandrian medicine to Islam, see Gul territorial expansion and state power, inherited Russell [20]. the Sasanian state apparatus and its scientifi c

29 ISTORIYA MEDITSINY (History of Medicine) 2015. Vol. 2. № 1 legacy [7, p. 5‒8]; the Sasanian state was largely as Alexandria was by that time not only the cultural based on Greek science. centre of Hellenism [28, p. 17] but also the place This transmission, according to Gutas, was where Galenism had become the predominant structurally framed in what he called the ‘imperial medical system. The fact that the region where ideology’ that the Abbasid Caliphate borrowed Islamic medicine was fi rst developed had already from the Sasanians for the establishment of their inherited a portion of Hellenistic sciences, in own Empire [21]. One should nevertheless bear philosophy, Aristotle and Plato, at the expense of in that the Sasanians were highly eclectic Epicureans and Stoics, and Hippocratic medicine in acquiring foreign sciences, and the Indian at the expense of theoretical developments of sciences, for instance, were no less common other schools such as the Methodists and the than the Greek sciences [11, p. 79‒80]. On the Pneumatics [29, p. 140], might explain why from other hand, the sciences of the Muslims, as a range of philosophical and medical ‘schools’ of Abu Rayhân Biruni emphasized, were almost the Hellenistic period, Aristotelian, Neoplatonic entirely depended on Greek learning and were philosophy and Galenic medicine became not infl uenced by Indian science [23, p. 8]. Even predominant in Islam. As early as the middle under Ullmann’s assumption, who in any case of the fourth century AD, Galen’s medicine acknowledges that they did not rely on direct had been completely dominant in the eastern evidence, “complete Greek medical works were Hellenistic world [30, p. 61]. translated into Pahlavi under Khorsrow I” [19, For Galen, philosophy and syllogistic p. 17, 18]. However, this was certainly not the reasoning were fundamental in medicine. His major conduit introducing Greek medicine into maxim that a good physician is philosopher Islam. Its predominance in Islam seems to stem [31, p. 1‒7], is reminiscent of the internal primarily from the fact that the integration of debates between ‘philosophical medicine’ and Greek sciences was part of the ideological and medicine tout court during pre-Hellenistic intellectual, or in other words, theology/faith- Hippocratic medicine [3, p. 49‒51]. But building process in the course of the formation more fundamentally, by giving importance of Islam itself [25]. to philosophy, Galen represented the A new religion, still in search of its dogma or epistemological shift that occurred during the ideology and within a socio-political framework Hellenistic period, principally during the third of confl ict between antagonistic powers and century BC, under Aristotle’s infl uence. A shift opinions, gave rise to intellectual debates from the Hippocratic tradition centred on the alongside political confl icts. The formation ‘problem of illness and clinic’ and was therefore of the four major Islamic schools of Ash‘ari, prone to ‘approximation and ’, to a Shâfe‘i, Hanafi and Mâleki took place in such medicine that also dealt with the state of health a context. Despite their (ideological) aversion and was thus eager to penetrate the opacity of for what was non-Islamic, all of these ‘schools’ the body by anatomy and dissection [32, p. came to adopt rational methods of arguing and 68‒71, 78]. Although this was based on animal debating, not only against each other but also to anatomy, it led Greek medicine towards a new confront objections coming from Christians and conception of the body and would in time, (claim Jews [26]3. to) be endowed with “scientifi c” precision. The Origins of the introduction of Greek medicine theoretical background of Aristotelian anatomy into Iran after Islam should also be sought in all was a teleological approach that established a regions that had undergone Hellenization since relationship between the structure of the organs their conquest by Alexander of Macedonia, and their ‘normal’ function. In other words, it before conquered by Islam. It seems that explained each organ in terms of its purpose. the conquest of Egypt in the fi rst decades of the Galen borrowed this approach and advocated Islamic expansion constituted the fi rst major step it in his De usu partium or Manâfe‘ al-a‘zâ’ [5, in the integration of Galenic medicine, inasmuch p. 70; 30, p. 41, 42] and in his other works [31]. It was this approach that was transmitted to 3 For a medieval source underlining incompatibility between Islamic physicians through Galen’s translations. Islam and rational sciences, see [27, p. 129]. Several physicians, including Ebn Sinâ, wrote

30 H. Ebrahimnejad treatises entitled Manâfe‘ al-a‘zâ’, emulating meant observations made during dissection or Galen’s book4. what was “theoretically observable”, that is, Bringing Islamic anatomical tracts into focus admitting the of a structure or function would help us to better understand Galen’s that was invisible in anatomy but deemed infl uence because anatomy was the foundation of necessary for the system – a concept belonging Galen’s physiopathology. It was the Aristotelian to Erasistratus [32, p. 86], is not clear. Partially, heritage which Herophilus and Erasistratus had this conceptual uncertainty fi nds its in Galen’s taken up before Galen. However, as mentioned, own ambiguity. Galen’s sensual as a they failed to resolve problems of incompatibility method of diagnosis and treatment [as versus the between Hippocratic clinical practice and pure speculative medicine] [33, p. 119], should Aristotelian anatomy, between what could be not be overemphasised. Although Galen insisted seen in anatomy and the entities and structures on dissection and anatomical experience, these that could not be seen (such as pneumata). The were exclusively carried out on animals (mainly resolution of this issue was necessary to complete apes, pigs, sheep and goats) and not on human the theoretical puzzle5. But the inability of the cadavers. During Galen’s life, Roman authorities followers of Herophilus and Erasistratus to solve forbade human dissections and vivisections the other problem that resulted from Aristotle’s [36]. As a result, Galen’s description of human infl uence, namely the lack of theoretical anatomy was also based on analogical reasoning. connection, or continuity, between anatomic- However, it is safe to say that unlike Galen, for physiology and clinical therapeutics, led to the whom “observation” meant both physical and abandonment of anatomy based on observation theoretical observation, for Islamic anatomists and dissection. There was a return to reliance the predominant method was qiyâs (syllogistic on (the commentaries of) Hippocratic texts [32, reasoning), even for an original discovery such p. 83, 84]. Galen, on the other hand, employed as Ibn Nafi s’ discovery of pulmonary transit of the teleological approach of Aristotle to close the blood [37, p. 275; 38]7. gap that was inevitably created when zoological Galen always recommended for physicians anatomy, practised by Aristotle, was to be used to to observe Nature for themselves by carrying explain organs and their functions in the human out individual dissection rather than accepting body. the ideas and writings of their predecessors or In Islamic medicine, the terms moshâhada contemporaries. Almost all of Galen’s principles (observation) and qiyâs (analogical/syllogistic and rationale for the necessity of anatomy and reasoning) were based on Greek concepts. dissection were accepted and emphasized by However, due to philological problems due physicians in Islamic lands. In the introduction translation and the epistemological diff erences to his book on tashrih, Abol-Majd Tabib al- between Galen and Islamic physicians, they Baizâvi (writing before 1056/1646) provides two diff ered from the original Greek. Ebn Elyâs, for reasons why anatomy (tashrih) is important: instance, in discussing various opinions about the First because by knowing the human body one hierarchy of the organs and precedence of their realises the power of the creator, God. Second, formation in the foetus, based his own argument if a physician knows about tashrih, a description that the heart was formed before brain (Aristotle’s of the human body, he would avoid mistakes view) on qiyâs, even though he acknowledged when administering cures and medications. that “Aristotle’s method was moshâhada and not In fact, Baizâvi is repeating the two reasons qiyâs and that for the anatomists moshâhada was put forward by Galen for the necessity of preferable”6. Whether by moshâhada Ebn Elyâs anatomy. But he does not give any indication as to how a physician should proceed to acquire 4 See the short treatise of Ebn Sinâ (Arabic manuscript, anatomical knowledge or surgical skill. Unlike Majles Library, Tehran, Ms No 14, p. 27‒36) [34]. Galen, Baizâvi does not refer to any dissection 5 On this question see Mario Vegetti [32, p. 91]. 6 Ahmad b. Elyâs, Tashrih-e Mansuri [35, fol. 2]; On performed by him. Following other anatomy Ebn Elyâs anatomy and Greek sources of the anatomical texts, Baizâvi’s book is divided into bâbs and illustrations in his Tashrih-e Mansuri, see Gül Russel (in Enc. Iranica, vol. VIII: 16‒20). 7 For a detailed discussion on this subject see [8, p. 46‒48].

31 ISTORIYA MEDITSINY (History of Medicine) 2015. Vol. 2. № 1 fasls, each fasl describing one organ, such as is known for his clinical/experimental approach, eye, ear, mussels, bones, their functions and addressed and criticised Galen’s thinking from their usefulness [35, fols 1‒2]. philosophical dimension and not from medical ‘Abdol-Razzâq (whose dates are unknown) viewpoint10. In any event, not in a way that would in his Kholâsat al-tashrih (Digest of anatomy), associate medical experimentation and theoretical emphasizes the importance of anatomy in knowledge. Interest in practical utility rather than medicine, stating that without this knowledge theoretical innovation in Persian medicine is a physician cannot accurately conduct his refl ected in the tracts and handbooks that grew practice. However, just like Baizâvi, ‘Abdol in medical literature, particularly after 13th‒14th Razzâq’s sources are not his own anatomical century. Generic titles, such as Dastur al-‘alâj experience but writings of , Majusi, (Prescription for Treatment), Kholâsat al-hekmat Ibn al-Nafi s Qurashi (d. 687/1288) and others8. (Digest of Medical Knowledge), Favâ’ed al-Yusofi Likewise Bokhâri in his Hedâyat al-Mote‘allemin (The Useful [Advices] of Yusofi ), etc., refl ect this (10th century AD) Baizâvi explicitly states that idea. the number of muscles were observed by Galen In medieval Iran, and up to the nineteenth but that he had not observed them himself century, the medical profession was characterised [39, p. 60]. A more recent example is ‘Aqili-ye by a lack of any specifi c institutions to distinguish Khorâsâni (writing in India in the second part genuine physicians from the charlatans, opening of the eighteenth century) who, recommending the medical market to everyone who claimed dissection of cadavers according to Galen’s medical knowledge and expertise. Raphael du method of immersing cadaver in the water Mans, visiting Esfahan around 1684, reported to better observe veins and arteries, does not that the impersonator doctors set up their mention a practical case of dissection which he cabinet any place in the city where they found himself had conducted [40, p. 31]. Almost all no other doctors nearby and women fl ocked to other anatomical texts by Persian physicians are them with their children, as if they were the new compilations of other books and do not refl ect Hippocrates [44, p. 353]. In such a situation, practice of anatomy and surgery. the textual knowledge of Galenic medicine was While theoretical practice in Hellenistic used to assert one’s professional status. In order medicine were grounded on anatomical to distinguish themselves from rank and fi le observations, which after a period of abandon doctors, learned physicians relied on theoretical from the second part of the third century BC and literary knowledge as well as on skill. Their onward was taken up by Galen in the second position could be reinforced by systems of century AD, in Islamic medicine anatomy-based examination and institutions represented by theoretical innovation were almost non-existent. the offi ce of mohtaseb11. Bokhâri (10th century), This may explain why ‘Abdol-Razzâq, just as Ebn in his Hedâyat al-mote‘allemin12, distinguished Elyâs, accepted the incorrect theories of Galen true physicians from rank and fi le practitioners, and Avicenna rather than the correct ones of Ibn based on their ability to use syllogistic reasoning al-Nafi s on blood circulation9. Similarly, lack of (qiyâs); the latter, according to him, lacked such anatomical observation led outstanding physicians, ability. Classical works on the history of Islamic such as Bahâ’ al-Dowleh Nurbakhshi and Emâd medicine written in the medieval period, such as al Din Mahmud Shirâzi (physician to Shah Abbas the al-Fihrist of Ibn al-Nadim (died 995/998), the I), to continue repeating the millenary theory, Tabaqât al-hokamâ of (976-1009), the following Avicenna (Canon, IV: 5). According to Târikh al-atebbâ of Ibn al-Qifti (d. 1248),or the this theory, the arteries carried blood and spirit, ‘Uyun al-anbâ’ fi Tabaqât al-atebbâ’ of Ibn Abi ruh [42, 43]. The hiatus between medicine and/ or anatomy on the one hand, and philosophy, on 10 Mohaqqeq: 53. 11 the other, fi nds an expression in the Shukuk alâ For question dealing with examinations, imtihân, assessing the capability of physicians see: Gary Leiser & Nouri Al- Jâlinus, where Mohammad Zakariyâ Râzi, who Khaledy [45], specially p. 8‒9; see also M. Dols [7, p. 33, 8 Persian MS, Khanikoff 154, St Petersburg, National 34], on the medical inspector, Muhtaseb, see G. Leiser [46]. Library, fol. 3. 12 Manuscript version, fols. 508, 626, cited by de Crussol des 9 ‘Abdol-Razzâq, fol. 51; Elgood [41]. Epesse, 2004: 240.

32 H. Ebrahimnejad

Usaybi (died 1270), consist of bibliographies of knowledge, would become the craft of non- physicians, learned at diff erent stages of Galenic physicians. or Hippocratic medicine. To be sure, empirical anatomy and surgery Nevertheless, humoral theory also permeated were lacking in medieval Islam and Christendom folk medicine and Galen’s infl uence is obviously alike. It could not be otherwise: setting aside the refl ected in manuals of popular medicine. In a potential religious and fi qh (Islamic jurisprudence) book entitled Khavâss al-ashyâ’, an anonymous impediments, invasive surgical operation in the author emphasizes the magical power of objects, technical and material conditions of the time were animals or parts of dead animals or humans. Along fatally lethal. Dissection of cadavers in hot regions with their natural properties, the author refers to of the Islamic lands was impracticable. This lack Galen’s idea about the humoral qualities of these of social and practical function of anatomy led it ashyâ’ [47, p. 4, 12, 13, 36]13. A mixture of the to become a purely descriptive, if not speculative, natural properties and magical powers of drugs is subject in medieval Islam [51, 129]. apparent in Pliny’s work and in Galen’s writings, However, material and technical impracticality despite the assumption that Galen’s ideas were all alone do not explain why dissection and surgery rational [48]. Therefore, it seems that the origin did not develop in Islamic medicine since these of this infl uence goes beyond Galen. Perhaps it is technical shortcomings could be overcome in more accurate to talk about parallels in diff erent some circumstances, like the developments that civilisations. The above-mentioned Khavâss al- occurred in the West from fi fteenth century ashyâ’ is quite similar in content to Part Three onwards. As far as this goes, religious and of a Syriac medical text, known as Syriac Book theoretical factors seem more fundamental. of Medicine, probably written in the sixth or Resistance to any “innovation” in medieval Islam seventh century. The latter contains folk remedies is illustrated in a Persian source, probably of the partly based on the natural properties of certain Ilkhanid period, in which ‘bad‘at’ revision and medicinal substances. Others rely on the magical ‘qiyâs’ (analogical deduction), are considered powers of objects, such as a dog’s tooth hung worse than ‘sherk’, or atheism14. To be around one’s neck prevents being bitten by a rabid sure, such a stance towards qiyâs was not shared dog [8, p. 19, 20]. One may also view Galen’s by all Islamic jurists. In fact, by the end of the infl uence on the medicine of the Prophet within ninth century C.E., qiyâs was one of the sources the framework of these parallels and similarities or criteria for the elaboration of Islamic law (the [8, p. 24; 49]. three others being the Quran, the sunna and the The fact that Galen was the most respected ij mâ‘ (juristic consensus). But in this case, qiyâs medical reference in Iran did not prevent the had to have “its starting point in the principles of development of a gap between Galen’s ideas the Quran, sunna or ij mâ‘” [53, p. 3, 4] and was and the application or perception of those ideas. never meant to provide a legal/juristic method for This might be explained by the fact that although innovation. in Iran Galen was cited more frequently than As mentioned above, the exact connotations Hippocrates, Hippocratic bedside medicine was of the terms moshahada and qiyâs have yet to favoured at the expense of practical anatomy be precisely defi ned. But there is a that in and surgery, which was fundamental for Galenic medieval Islam moshâhada was associated with physiology. Bahâ’ al-Dowleh Nurbakhshi (died sensual experience. Therefore, it could not have in 1508‒1509) [50, p. 64], for instance, did been widely observed or practiced and some not practice surgery but advised calling in a leading physicians and philosophers vociferously surgeon for surgical cases [51, XIV]. This was in voiced against it. According to Fakhr al-Din-e conformity with the Hippocratic Oath, advising Râzi (1149‒1209), of Shâfe‘î persuasion, rational doctors not to make incisions and to confer perception, edrâk-e ‘aqli, is superior to sensual such practice to specialists, i.e., surgeons. In perception, edrâk-e hessi15. It is in line with this time, surgery, intrinsically related to anatomical 14 See Anonymous [on the refutation of bad‘at] Persian MS, 13 For a copy of this tract written in or before the seventeenth National Library, St. Petersburg [52]. century see a Persian medical text ‒ at the British Library 15 Abridge version of Kanz al-Daqâyeq of Râzi, by an dated 18 Jamâdi II 1100/April 1689. anonymous author, Persian manuscript, Khanikof 19,

33 ISTORIYA MEDITSINY (History of Medicine) 2015. Vol. 2. № 1 philosophy that Fakhr al-Din-e Râzi based speculative repetition or in a few cases re-, or his anatomical work entirely on teleology. mis-, interpretation. Galen’s theory of humours Following Aristotle, Fakhr al-Din Râzi believed goes beyond Hippocrates [5, p. 52‒54]. Just as in that the first organ created was the heart. This anatomy, Galenic humoral theory was infl uenced is not because the heart’s muscle is stronger by Aristotelian philosophy [29, p. 145]. Galen and harder, but because the heart is the seat of conceived of things as composed of four elements: knowledge and thought. Therefore, the heart fi re, air, earth and water. These elements were is the sovereign in the body, with other organs formed by the union of the and the four being its subjects. There are many bones of the qualities of hot, cold, dry and moist. In the head so that the heat of the body that tends body, these elements are represented by the four to rise could leave through sutures between humours respectively: blood, phlegm, black bile, the head’s bones16. Ebn Sina provides similar and yellow bile. These humours are produced by arguments, but for him, instead of the heat of the process of digestion of food and drink and air the body, the vapour arising from brain escapes entering the body through respiration. What is through the sutures [34, I, p. 56]. found in the vein is in fact a mixture of the four It seems that Islamic anatomists, despite humours and not only blood [30, p. 17]. The the Aristotelian infl uence, never grasped the balance between the quantities or qualities of the epistemological link between animal dissection humours maintained health, and their imbalance and medical knowledge. Often, the lack caused . of dissection in Islam is attributed to legal According to Bahâ’ al-Dowleh, after being prohibition. However, this prohibition has digested in the stomach through the help of the always been a matter of interpretation rather heat of the stomach and surrounding organs, than on a fi rm religious ban. Galen did not food is fi rst transformed into Kilus, a substance proceed to human dissection either, no matter like kashk (whey). The fi nest and most cooked what the rationale was behind such avoidance. parts of the kilus are absorbed by the jegar (the However, the fundamental diff erence between liver) through minor veins, after being moved Galen and his Islamic followers was that the by the mâsâriqâ veins that relate the bottom of former widely practiced animal dissection and the stomach to the liver. The liver and its heat the latter did not. The reason seems to be not further digests the kilus. This cooking operation only than Moslem anatomists in general based (tabkh) produces three substances: the fi rst, safrâ their anatomical knowledge on text rather than (yellow bile), is like foam and fl oats on the top. on experience, but also on the belief that humans The second is the sowdâ (black bile) and the most were the noblest creature of God. Although refi ned part is the blood. If there is a failure in there is no explicit statement that relates this the cooking operation in the liver, what remains principle with the state of anatomy in Islam, it uncooked (khâm) is called balgham (phlegm). But is not hard to understand that it had certainly the production of phlegm in the liver is far less infl uenced Islamic physicians and their ideas than in the stomach and intestines, while blood is about animal anatomy and its epistemological produced only in the liver17. relation with medical knowledge. Setting aside According to Galen, there are nine types of Galen’s pagan culture, or his attachment to temperaments: One ideal, in which all qualities Aristotle’s worldview, the sole extent of animal are balanced. Four, in which one of the qualities, dissection as the source of his writings indicates hot, cold, dry or moist predominates and four that he believed in a sort of affi nity or continuity others, in which the predominating qualities between animal and human structure and appear in couples of hot and moist, hot and dry, extrapolated the function of human body from cold and moist, cold and dry. Following Galen, his research on animal cadavers. Persian physicians believed in nine types of nature In the matter of humoral theory as well, (mazâj). The ‘absolute balanced nature (mezâj-e Galen’s infl uence was represented with mo‘tadel-e haqiqi), in which all humours are equal in quantity and quality; this mazâj does not exist St Petersburg, National Library, fols. 114‒115. 16 Ibid, fol. 161. 17 Kholâsat al-Tajârob, fol. 4 a [43].

34 H. Ebrahimnejad in the . In the reality, natures are twofold: authority, or the intrinsic sense of his advice, basitah (simple) and morakabbah (compound). that is, critical vision and spirit of inquiry, has Simple natures are four: hot, cold, moist and dry. yet to be investigated. The compound natures are also four: hot and dry, Occurrences of new ideas within the cold and dry, hot and moist, cold and moist [43, framework of humoral theories were exceptions fol. 2a; 54]. The major diff erence is that, unlike to the predominating rule of compilation and Persian physicians, for Galen the well-balanced respect of tradition. The common presumption temperament existed [30, p. 19]. For both Galen dividing Islamic medicine into two periods, and Islamic physicians the balanced-temperament Golden Age and stagnation, appears to be was a point of reference to diagnose illness. mistaken. Such exceptions, or more precisely, However, for Galen the balanced temperament “relative independence from transmitted could be found in ordinary people, for the Islamic learning or textual authorities” [55, p. 387, physicians this was the characteristic of the holy 388], did not end with Razi and Ebn Nafi s. One Imams [43, fol. 2a]. fi nds them with Bahâ’al-Dowleh Nurbakhshi, Quite similar to the Roman Empire, where the whose clinical approach has duly been noticed compilation, summaries and commentaries on and praised by Elgood. In his Kholâsat al- Galen’s works dominated medical literature18, in Tajârob (Quintessence of Experience) Bahâ’al- Iran after Islam compilation rather than creation Dowleh gives the fi rst description of Whooping characterised medical literature. Commentary Cough19, while his narrative and style of writing became the dominant genre in medical demonstrates his independence of mind rather literature, especially after Ebn Sinâ, on whose than compilation. Similarly, Mirzâ Qâzi b. Canon several commentaries were written. This Kâshef al-Din Mohammad-e Yazdi (died in ca. included the Sharh-e Emâm Fakhr-e Râzi, the 1664‒1665) in his treatise, Resâlah dar qahwa va commentary of Qotb al-Din Shirâzi titled Tohfat chai va pâzahr va chub-e chini, refuting the idea al-Sa’diya (682/1283); the Sharh-‘ Mujiz al- of ‘Emâd al-Din Mahmud, who had maintained Qânun by Nafi s b. ‘Evaz-e Kermâni, which was a that the China Root was hot, contended that commentary on the commentary of Ibn al-Nafi s the China Root is not hot at the fi rst degree but al Qurshi, Mujiz al-Qânun (the commentary cold and, furthermore, that it is not the quality on Canon in which he refuted Galen and Ebn of hot or cold in the drugs that operates but Sinâ’s ideas on the passage of blood between another that has nothing to do with hot the two ventricles of the heart), the Sharh al- and cold. By the same token, Yazdi refutes the Maghnâ of Mowlânâ Sadid al-Din Kâzeruni, dominant Galenic theory, according to which the commentary on Canon (753/1352) by Shams every disease should be cured by its opposite. al-Din Mohammad b. Mahmud-e Amoli, the As proof, he mentions the curing eff ect of author of the Nafâyes al-Fonun, the Sharh-e teryâq-e fâruq that is hot but nevertheless Qânun of Hakim ‘Ali-Guilâni (died in 1609), good for typhus (hasba siyâh) which is also hot etc. [51, p. 77]. Some of these commentaries [56, fol. 2]. In fact, by objecting to the idea of were written in order to make the original text ‘Emâd al-Din Mahmud about the China Root, more readable, while others were inspired by a Kâshef-e Yazdi made an attempt to introduce a spirit of criticism, and in this it seems that their new concept, if not a new reading, of humoral authors were following Galen’s advice not to pathology that obviously diff ered from that of rely on ancient sources but to undertake original the hot-cold paradigm. He believed that each research. Zakariyâ Râzi, in his Shukuk al Jâlinus drug had its own quality made of a specifi c (Doubts about Galen), claims that in writing composition of diff erent properties (morakkab this book he followed this Galen’s advice [37, al-qovâ). Other infl uential physicians in the p. 277]. However, the extent to which Zakariyâ seventeenth and eighteenth centuries in Iran Râzi followed Galen, the supreme medical and in India such as Hakim Mir Mohammad (in his Tohfat al-Mo’menîn) and Akbar Arzâni 18 On the analogous social and intellectual context between (in his Qarâbâdin-e Qâderi) also believed that Byzantine and the Medieval Islamic world see Stromaier [in: Grmek, 124‒125]; [19, p. 22]. 19 Safavid Medical Practice: XII, XIV.

35 ISTORIYA MEDITSINY (History of Medicine) 2015. Vol. 2. № 1 drugs are multi-natured (morakkab al-qovâ), read by the anonymous author, based his medical but in this they followed Kâshef-e Yazdi. To give knowledge on tashrih (dissection/anatomy), another example of intellectual dynamism after practiced surgery in military campaigns [18, the so-called “demise of the Golden Age”, both p. 172] and took care of the gladiators in Nurbakhshi (Kholâsat al-Tajârob) and ‘Emâd Pergamon by cleaning and stitching their wounds al-Din Mahmud Shirâzi (Resâleh-ye Chub-e [5, p. 20; 29, p. 223]. Chini) recognised the contagiousness of syphilis, while Zakariyâ Râzi did not acknowledge the Conclusion contagiousness of either smallpox or measles. Galen’s work can be viewed as a watershed in The two trends, one guided by the spirit the history of Greek medicine. It created a more of criticism and research and the other inclusive Greek medical literature overcoming or characterised by respect of tradition and reconciling divergences among diff erent medical authority, continued side by side. However, schools. It was a work fundamental in medical despite criticisms, the humoral paradigm education. This achievement, however, occurred was never called into question until Sâlih b. at a time when Christianity was about to expand Nasr-allâ al-Halabi, called Ibn Sallûm, the its grips on science. Considering the historical court physician of Ottoman ruler, Sultân environment under the Byzantine Empire, char- Mohammad IV (r. 1648‒1687). He introduced acterized by the hostility of the Church towards the Paracelsian notion of iatrochemistry Greek science, the rise of Islam as a religion and (chemical medicine) into Islamic medical political entity, rival to both Christianity and the literature and developed pathology based not Byzantine Empire, played a fundamental role in on Galen’s humoral theory but on three basic the dissemination of Greek medicine. In order substances, salt, mercury and sulphur [19, to strive and expand, Islam needed ‘non-Islamic p. 50; 57]. The first Persian translation of science’ and knowledge. Furthermore, Islam Paracelsian medicine was made by Zeyn al- was born in a geographical and cultural space fa- ‘Âbedin Mashhadi Tabâtabâ’î in the second miliar with Hellenistic civilization. It provided a part of the eighteenth century from the Arabic favorable political and material context for a new translation of the work of Oswald Croll by Ibn departure of Greek science. Nevertheless, the Sallum. At least two other Persian translations same factors that provided an opportunity for of Ibn Sallum’s book, Ghâyat al-itqân fi tadbir-i the revival of Greek science was also responsible badan al-ensân, were made during the first part for its alteration and corruption. If Greek science of the nineteenth century in Iran. was born and developed in a historical context Islamic medicine’s preference for that allowed Plato, Aristotle and Hippocrates to Aristotelian universals, to the exclusion of thrive, after its adoption by Islam it developed Galenic experimental medicine, played an in a diff erent historical and socio-political envi- enduring role in the way medicine developed in ronment and culture, specifi c to the Omayyad Islam until the sweeping waves of modernisation and Abbasid Caliphates and thereafter. Greek in the nineteenth century. These changes medicine was no longer a corpus of knowledge were propelled by political factors and by the that could develop unfettered and studied by free pressures of an increasing number of soldiers thinkers. It was represented in a special way and injured by bullets, reminding physicians of the it had to be understood as its step-father, Islam, importance of surgery and anatomy in medicine. wanted. In this article, I have tried to underline An army physician of traditional education the major intellectual, socio-political and mate- in mid-nineteenth-century Iran, advocating rial factors that were the basis of how Galen was the improvement of surgical skills amongst understood and studied by Islam. This should medical profession, criticised Hippocrates help understand why in the seventeenth century for downgrading the importance of surgery in we witnessed a huge gap between Islamic physi- medicine20. Signifi cantly, he did not criticize cians who learned, taught and practiced medi- Galen. According to Ibn al-Qifti, very probably cine through text, and Descartes who studied natural science, cultivated plants and dissected 20 Anonymous MSS; in H. Ebrahimnejad [58, p. 227, 228]. animals.

36 H. Ebrahimnejad

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About the author Ebrahimnejad Hormoz – Doctor of Philosophy, Professor of Faculty of Humanities University of Southampton (UK). E-mail: [email protected]

The name of the article for quotation: Galen as Read and Perceived by Medieval Islamic Medicine. Istoriya meditsiny (History of Medicine). 2015. Vol. 2. № 1. P. 33–45.

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